Daniel Rayson

Evaluating Survivorship Care Plans: Results of a Randomized, Clinical Trial of Patients With Breast Cancer

PURPOSEnAn Institute of Medicine report recommends that patients with cancer receive a survivorship care plan (SCP). The trial objective was to determine if an SCP for breast cancer survivors improves patient-reported outcomes.nnnPATIENTS AND METHODSnWomen with early-stage breast cancer who completed primary treatment at least 3 months previously were eligible. Consenting patients were allocated within two strata: less than 24 months and ≥ 24 months since diagnosis. All patients were transferred to their own primary care physician (PCP) for follow-up. In addition to a discharge visit, the intervention group received an SCP, which was reviewed during a 30-minute educational session with a nurse, and their PCP received the SCP and guideline on follow-up. The primary outcome was cancer-related distress at 12 months, assessed by the Impact of Event Scale (IES). Secondary outcomes included quality of life, patient satisfaction, continuity/coordination of care, and health service measures.nnnRESULTSnOverall, 408 survivors were enrolled through nine tertiary cancer centers. There were no differences between groups on cancer-related distress or on any of the patient-reported secondary outcomes, and there were no differences when the two strata were analyzed separately. More patients in the intervention than control group correctly identify their PCP as primarily responsible for follow-up (98.7% v 89.1%; difference, 9.6%; 95% CI, 3.9 to 15.9; P = .005).nnnCONCLUSIONnThe results do not support the hypothesis that SCPs are beneficial for improving patient-reported outcomes. Transferring follow-up to PCPs is considered an important strategy to meet the demand for scarce oncology resources. SCPs were no better than a standard discharge visit with the oncologist to facilitate transfer.

Pegylated liposomal doxorubicin-associated hand–foot syndrome: Recommendations of an international panel of experts

BACKGROUNDnHand-foot syndrome (HFS) is dose-limiting and the most common cumulative toxicity associated with pegylated liposomal doxorubicin (PLD). It can cause considerable discomfort and lead to therapy interruption. Numerous approaches to HFS management have been reported, but there is no consensus.nnnMETHODSnPublished literature (identified via Medline and internet search) and expert experience regarding HFS and its pathogenesis, incidence, risk factors, prevention and treatment in patients undergoing treatment with PLD were collected and reviewed by a panel of experts. A consensus technique was used to develop recommendations.nnnFINDINGSnThe pathogenesis of PLD-associated HFS has been recently elucidated. Systems used to grade, prevent and treat HFS in individuals treated with PLD vary widely. A randomised clinical study demonstrated that PLD dose intensity reduction can prevent HFS. While there is limited literature support, patient education and supportive measures were endorsed by the expert panel as effective strategies for HFS prevention and treatment. An easy to use HFS grading and management algorithm was developed, early signs and symptoms of HFS outlined and specific recommendations for supportive care developed.nnnINTERPRETATIONnThe paucity of data on the management of PLD-associated HFS led the expert panel to develop consensus-based recommendations. Patient education and supportive measures are important elements in the management of HFS and dose intensity reduction has documented efficacy in prevention. At a PLD dose intensity not exceeding 10mg/m(2) weekly, HFS can be easily managed. Phase III research to support the efficacy other interventions is lacking.

Controlling angiogenesis in breast cancer: A systematic review of anti-angiogenic trials

PURPOSEnAngiogenesis is critical for tumor growth and a promising therapeutic target. This review will summarize and analyze data from clinical trials of anti-angiogenic agents in the treatment of breast cancer (BC).nnnDESIGNnA systematic search of PubMed and conference databases was performed to identify reports of randomized clinical trials investigating specific anti-angiogenic agents in the treatment of BC.nnnRESULTS AND DISCUSSIONnPhase III trials in advanced BC have demonstrated a reduction in the risk of disease progression (22-52%), improved response rates and net improvements in progression-free survival of 1.2 to 5.5 months, but no significant improvements in overall survival with the addition of bevacizumab to chemotherapy. Results of phase III trials in early breast cancer have been inconsistent. Bevacizumab-containing regimens have also been associated with higher overall adverse event rates compared to chemotherapy alone. Phase III trials of the tyrosine kinase inhibitor sunitinib were negative, while randomized phase II trials of sorafenib and pazopanib have improved some outcomes when combined with chemotherapy or targeted therapy compared to controls. In addition to expected vascular class safety signals, tyrosine kinase inhibitors show off-target side effects. Ongoing clinical trials evaluating combinatorial strategies based on biological synergies and translational studies identifying biological predictors of response will be crucial to establish meaningful clinical benefits in selected BC populations.nnnCONCLUSIONnMost trials of anti-angiogenic agents in BC have reported improved response rate and progression-free survival but no increase in overall survival compared to chemotherapy alone. Optimizing the therapeutic indices of these agents is a focus of ongoing research and will be critical to their future development.

Metastatic breast cancer: The role of pegylated liposomal doxorubicin after conventional anthracyclines

Anthracyclines demonstrate significant disease activity in breast cancer and are a key component of therapy in both early and advanced disease. It has been long recognized that these agents are associated with cumulative dose-related cardiotoxicity that often limits their utility at the time of disease recurrence. The risk of anthracycline-associated cardiotoxicity appears to be highest in women with HER2-overexpressing breast cancer previously having received an adjuvant anthracycline-trastuzumab regimen. Clinical trials have demonstrated that pegylated liposomal doxorubicin (PLD) is equally active but associated with a significantly lower risk of cardiotoxicity compared with conventional doxorubicin whether administered as monotherapy or in combination with trastuzumab. Thus, PLD can be effectively and safely substituted for conventional doxorubicin, allowing retreatment with an anthracycline in the metastatic setting. PLD has also been shown to improve time to tumor progression when used as maintenance therapy. These data, when coupled with the need to maintain efficacy and reduce cardiotoxicity in the management of metastatic breast cancer, support the use of PLD in the metastatic setting, as well as support the rationale for evaluating PLD as adjuvant therapy.

Outcome after ovarian/adnexal metastectomy in metastatic colorectal carcinoma.

Ovarian metastases are reported to occur in 3–8% of women undergoing surgical resection of a primary colorectal adenocarcinoma. Information on clinical outcome after metastectomy for these patients is limited.

Phase II Multicenter Trial of Anthracycline Rechallenge With Pegylated Liposomal Doxorubicin Plus Cyclophosphamide for First-Line Therapy of Metastatic Breast Cancer Previously Treated With Adjuvant Anthracyclines

PURPOSEnAnthracyclines are a component of breast cancer chemotherapy regimens in both adjuvant and metastatic settings. Anthracycline rechallenge for metastatic disease, for those previously exposed to adjuvant anthracyclines, may not be considered because of concerns about efficacy, tolerability, and cumulative cardiotoxicity.nnnPATIENTS AND METHODSnThis prospective, multicenter, single-arm, phase II trial examined the efficacy and safety of pegylated liposomal doxorubicin (PLD) 35 mg/m(2) plus cyclophosphamide 600 mg/m(2) as first-line therapy, delivered every 3 weeks, in 70 patients who developed metastatic disease more than 12 months after completion of an adjuvant anthracycline-containing regimen. Seven patients discontinued treatment early and were excluded from the efficacy analysis.nnnRESULTSnAfter a median of six cycles, the objective response rate was 38%. An additional 33% of patients achieved stable disease lasting more than 6 months, for an overall clinical benefit rate of 71%. The estimated median time to progression was 12.2 months. Median overall survival time was 16.5 months. Clinical response was equally robust in patients with and without prior taxane exposure. Treatment was well tolerated. The most common grade 3 to 4 toxicities were palmar-plantar erythrodysesthesia (PPE; 10%), dyspnea (9%), and neutropenia (9%). One (1.4%) of 70 patients discontinued treatment as a result of PPE. One patient (1.4%) experienced an infusion reaction requiring discontinuation. No symptomatic cardiac events were observed.nnnCONCLUSIONnPLD plus cyclophosphamide is effective and well tolerated in patients with metastatic breast cancer who have received prior adjuvant anthracycline-containing chemotherapy. The majority of patients experienced a clinical benefit without any significant impact on cardiac function.

Adherence to Clinical Practice Guidelines for Adjuvant Chemotherapy for Colorectal Cancer in a Canadian Province: A Population-Based Analysis

PURPOSEnClinical practice guidelines (CPGs) recommend adjuvant chemotherapy after curative-intent surgery for colorectal cancer (CRC). Studies have shown variable rates of adherence to adjuvant therapy CPGs. This study sought to determine the proportion of patients in Nova Scotia receiving CPG-concordant adjuvant chemotherapy within 12 weeks of surgery for CRC in 2001 to 2005, and to identify factors associated with chemotherapy receipt beyond 12 weeks from surgery or chemotherapy nonreceipt.nnnMETHODSnPatients with stages IIB or III colon or stages II or III rectal cancer who underwent curative-intent surgery in Nova Scotia were identified through the provincial cancer registry and anonymously linked to 14 administrative health databases. Chart review was conducted to obtain chemotherapy data and reasons for chemotherapy nonreceipt. Logistic regression was used to identify factors independently associated with receipt of chemotherapy and meeting the 12-week benchmark (P < .05).nnnRESULTSnA total of 1,151 patients were identified, of whom 59% received chemotherapy. Factors predicting chemotherapy receipt were male sex, age < 75 years, no hospital readmission within 30 days of surgery, stage III disease, no prior cancer diagnosis, and rectal cancer. Of the 679 patients who received chemotherapy, 479 (72%) met the 12-week benchmark, with male sex, urban residence, less social deprivation, colon cancer and increased length of hospital stay as significant factors. Of the 472 patients who did not receive chemotherapy, the most common reason for nonreceipt was no consultation with a medical oncologist (53%).nnnCONCLUSIONnA number of factors influence adherence to adjuvant chemotherapy CPGs for CRC and should be incorporated in future work as novel regimens enter clinical practice.

Identifying patients at high risk for neutropenic complications during chemotherapy for metastatic breast cancer with doxorubicin or pegylated liposomal doxorubicin: the development of a prediction model.

Objective:To develop a cycle-based risk prediction model for neutropenic complications (NC) during chemotherapy with doxorubicin (DOX) or a pegylated liposomal formulation (PLD) for patients with metastatic breast cancer (MBC). Methods:Data analyzed was from a phase III, randomized clinical trial of DOX (60 mg/m2 every 3 weeks) or PLD (50 mg/m2 every 4 weeks) for the first line therapy for MBC (n = 509) (O’Brien et al, Ann Oncol. 2004;15:440–449). NC were defined as an absolute neutrophil count ≤1.5 × 109 cells/L (ie, ≥grade II) before the next cycle, febrile neutropenia or neutropenia with a documented infection. Patient and hematologic factors potentially associated with NC were evaluated. Factors with a P value of ≤0.25 within a cycle were included in a generalized estimating equations regression model. Using backward elimination, we derived a risk scoring algorithm (range 0–63) from the final reduced model. Results:Risk factors retained in the model included poor performance status, absolute neutrophil count ≤2.0 × 109 cells/L in the previous cycle, the first cycle of chemotherapy, DOX versus PLD and advanced age. A precycle risk score from ≥25 to <40 for a given patient was identified as being the optimal threshold for sensitivity (58.0%) and specificity (78.7%). Patients with a score at or beyond this threshold would be considered at high risk for developing NC in later cycles. Conclusion:The use of this model may enhance patient care by targeting preventative therapies (eg, granulocyte colony stimulating factor or PLD) to those MBC patients most likely to experience NC during anthracycline-based chemotherapy.

To The Last Drop

Of course, from childhood to forever, we are always thought to love reading. It is not only reading the lesson book but also reading everything good is the choice of getting new inspirations. Religion, sciences, politics, social, literature, and fictions will enrich you for not only one aspect. Having more aspects to know and understand will lead you become someone more precious. Yea, becoming precious can be situated with the presentation of how your knowledge much.

Decision-making by surgeons about referral for adjuvant therapy for patients with non-small-cell lung, breast or colorectal cancer: a qualitative study

BACKGROUNDnBecause surgeons are the main gatekeepers to oncology services, understanding how they make decisions related to referral for adjuvant therapies is important to optimize referral rates and use of oncology services for patients with potentially curable disease. We examined decision-making by surgeons related to referral to oncology services for patients having undergone curative-intent surgery for non-small-cell lung, breast or colorectal cancer.nnnMETHODSnWe conducted a qualitative study, whose design was guided by the principles of grounded theory. Semi-structured interviews were held with 29 surgeons who performed non-small-cell lung, breast or colorectal cancer surgery in the province of Nova Scotia. Data were collected and analyzed concurrently. Analysis involved an inductive, grounded approach using constant comparative analysis. Data collection and analysis continued until theoretical saturation was reached.nnnRESULTSnSeven factors influenced the surgeons decision-making related to referral to oncology services: indications and contraindications for therapy; patients beliefs and preferences; a belief that oncologists are the experts; knowledge of local standards of care; consultation with oncology colleagues; navigating patient logistics (e.g., lodging, caregiving responsibilities, insurance coverage); and system resources and capacity.nnnINTERPRETATIONnOur studys findings provide a novel understanding of how surgeons make decisions about oncology referral and point to potential areas for intervention to promote referral to oncology services for patients for whom adjuvant therapy is recommended.